- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.32 / $888.93 / $8,676.76
| Facility | | $680.32 | $888.93 | $8,676.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.93 / $8,676.76 / $13,065.10
| Professional | | $888.93 | $8,676.76 | $13,065.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,930.26 / $2,444.31 / $19,065.62
| Professional | | $1,930.26 | $2,444.31 | $19,065.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.47 / $6,306.33 / $7,247.91
| Professional | | $973.47 | $6,306.33 | $7,247.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,554.24 / $48,933.97 / $55,995.55
| Facility | | $26,554.24 | $48,933.97 | $55,995.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.04 / $4,592.56 / $8,091.88
| Professional | | $435.04 | $4,592.56 | $8,091.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,623.19 / $6,258.16 / $15,352.40
| Professional | | $3,623.19 | $6,258.16 | $15,352.40 |